<link rel="stylesheet" href="__STATIC__mobile/css/cart.css">
<link rel="stylesheet" href="__STATIC__mobile/css/buy.css">
<link rel="stylesheet" href="__STATIC__mobile/css/addressManage.css">

<script src="__STATIC__mobile/js/areadata.js"></script>
<script src="__STATIC__mobile/js/myarea.js"></script>

<div class="membersbox pad50">

    <form action="" method="post" id="form" class="">
    

<div class="msettlement_goods_con">
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl"><span style="color:red;">*</span>收货人:</section>
						<section class="content-input fl">
							<input class="text" maxlength="5" value="<?php echo $delivery['delivery_name'];?>" name="delivery_name" placeholder="必填，收货人真实姓名">
						</section>
					</section>
				</section>
				
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl"><span style="color:red;">*</span>电话:</section>
						<section class="content-input fl">
							<input type="tel" class="text" maxlength="18" value="<?php echo $delivery['delivery_mobile'];?>" name="delivery_mobile" placeholder="必填，收货人电话号码">
						</section>
					</section>
				</section>
				
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl"><span style="color:red;">*</span>省份:</section>
						<section class="content-textarea fl">
							<select id="province" name="province" style="width:200px;"></select>
						</section>
					</section>
				</section>
				
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl"><span style="color:red;">*</span>城市:</section>
						<section class="content-textarea fl">
							<select id="city" name="city" style="width:200px;"></select>
						</section>
					</section>
				</section>
				
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl"><span style="color:red;">*</span>区域:</section>
						<section class="content-textarea fl">
							<select id="county" name="county" style="width:200px;"></select>
						</section>
					</section>
				</section>
				
				
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl"><span style="color:red;">*</span>详细地址:</section>
						<section class="content-input fl">
							<input class="text" maxlength="60" value="<?php echo $delivery['address'];?>"  name="address" placeholder="必填，详细地址">
						</section>
					</section>
				</section>
				
				<section class="fixinline pdl10">
					<section class="textarea_content clearfix">
						<section class="content-name fl">微信号:</section>
						<section class="content-input fl">
							<input class="text" maxlength="20" value="<?php echo $delivery['wechat_user'];?>"  name="wechat_user" placeholder="选填，您的微信号码">
						</section>
					</section>
				</section>

</div>
        	
			<section class="actions" style="width:80%;text-align:center;margin-left:10%;margin-top:20px;">
					<a href="javascript:AjaxFormSubmit();" class="mbtn btn-success btn-big J_pay" >提 交</a>
			</section>
        	
	 </form>

</div>

<script type="text/javascript">
city.getcity('province','city','county','<?php echo $delivery['province'];?>','<?php echo $delivery['city'];?>','<?php echo $delivery['county'];?>',1);
</script>

<include file="Common:nav" />
